Diagnostic presentation HeadacheUnited States Universit
Diagnostic presentation Headache United States University Introduction Headache is the most common pain in the united states. Headache means pain or discomfort in the head, face, or neck. Headache can be caused by inflammation or spasm related to cranial vessels, nerves, or muscles Headache can be primary or secondary. (Dlugasch & Story, 2021) Classification of headache Primary headache Most common, not a symptom of underlying an underlying disease Benign Can be recurrent It mainly occurs early in an individual Decrease after ages 40 to 50 Migraine Tension-type headache Trigeminal autonomic cephalgia Other primary headache disorders (Rizzoli & Mullally, 2018). Secondary headache Caused by an underlying condition Trauma or injury to the head or neck Cranial or cervical vascular disease Nonvascular intracranial disorder A substance or its withdrawal Infection Affliction of homeostasis Illness of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure Psychiatric disorder (Rizzoli & Mullally, 2018). The red flag of headache If an older patient complaint of New headache Abnormal neurologic examination such as mental status changes and papilledema If there is any New change in the headache pattern Intensifying headache New headache if in case of HIV risk factors, cancer, or an immunocompromised status Systemic illness signs (e.g., fever, stiff neck, rash) If precipitate by cough, exertion, Valsalva maneuver If the Headache in pregnancy or postpartum period If a patient says it is the First or worst headache of my life (Rizzoli & Mullally, 2018). Pathophysiology of headache Stimulation of primary nociceptors Lesions in the pain-producing pathway of PNS and CNS Pain producing structure Scalp Middle meningeal artery Dural sinuses Flax cerebri Proximal segment of the large pial arteries (Dlugasch & Story, 2020) Pathophysiology of headache continue There are no nociceptors in the brain parenchyma So the pain originates from surrounding structures, such as blood vessels, meninges, muscle fibers, facial structures, and cranial or spinal nerves. Any stretching, dilatation, constriction, or any nociceptor when they stimulate stimulation structures can cause the perception of headache. The secondary headache depends on the cause and diseases ( Rosenthal & Burchum, 2021) migraine headache Migraine headache is a headache associated with systemic complaints. The person feels a severe throbbing pain or a pulsing sensation, usually on one side of the head, along with nausea, vomiting, and extreme sensitivity to light and sound. The attacks can last for hours to days, and the pain can be severe that it interferes with daily activities (Dlugasch & Story, 2020). Triggers to migraine headache Emotional stress Hormonal change during menstruation Alcohol intake Change in weather Odors Disturbance in sleep or not getting enough sleep migraine heada ...
Diagnostic presentation HeadacheUnited States Universit
Diagnostic presentation Headache United States University Introduction Headache is the most common pain in the united states. Headache means pain or discomfort in the head, face, or neck. Headache can be caused by inflammation or spasm related to cranial vessels, nerves, or muscles Headache can be primary or secondary. (Dlugasch & Story, 2021) Classification of headache Primary headache Most common, not a symptom of underlying an underlying disease Benign Can be recurrent It mainly occurs early in an individual Decrease after ages 40 to 50 Migraine Tension-type headache Trigeminal autonomic cephalgia Other primary headache disorders (Rizzoli & Mullally, 2018). Secondary headache Caused by an underlying condition Trauma or injury to the head or neck Cranial or cervical vascular disease Nonvascular intracranial disorder A substance or its withdrawal Infection Affliction of homeostasis Illness of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure Psychiatric disorder (Rizzoli & Mullally, 2018). The red flag of headache If an older patient complaint of New headache Abnormal neurologic examination such as mental status changes and papilledema If there is any New change in the headache pattern Intensifying headache New headache if in case of HIV risk factors, cancer, or an immunocompromised status Systemic illness signs (e.g., fever, stiff neck, rash) If precipitate by cough, exertion, Valsalva maneuver If the Headache in pregnancy or postpartum period If a patient says it is the First or worst headache of my life (Rizzoli & Mullally, 2018). Pathophysiology of headache Stimulation of primary nociceptors Lesions in the pain-producing pathway of PNS and CNS Pain producing structure Scalp Middle meningeal artery Dural sinuses Flax cerebri Proximal segment of the large pial arteries (Dlugasch & Story, 2020) Pathophysiology of headache continue There are no nociceptors in the brain parenchyma So the pain originates from surrounding structures, such as blood vessels, meninges, muscle fibers, facial structures, and cranial or spinal nerves. Any stretching, dilatation, constriction, or any nociceptor when they stimulate stimulation structures can cause the perception of headache. The secondary headache depends on the cause and diseases ( Rosenthal & Burchum, 2021) migraine headache Migraine headache is a headache associated with systemic complaints. The person feels a severe throbbing pain or a pulsing sensation, usually on one side of the head, along with nausea, vomiting, and extreme sensitivity to light and sound. The attacks can last for hours to days, and the pain can be severe that it interferes with daily activities (Dlugasch & Story, 2020). Triggers to migraine headache Emotional stress Hormonal change during menstruation Alcohol intake Change in weather Odors Disturbance in sleep or not getting enough sleep migraine heada ...
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Diagnostic presentation HeadacheUnited States Universit
- 1. Diagnostic presentation Headache United States University Introduction Headache is the most common pain in the united states. Headache means pain or discomfort in the head, face, or neck. Headache can be caused by inflammation or spasm related to cranial vessels, nerves, or muscles Headache can be primary or secondary. (Dlugasch & Story, 2021) Classification of headache Primary headache Most common, not a symptom of underlying an underlying disease Benign Can be recurrent It mainly occurs early in an individual Decrease after ages 40 to 50 Migraine Tension-type headache Trigeminal autonomic cephalgia Other primary headache disorders (Rizzoli & Mullally, 2018).
- 2. Secondary headache Caused by an underlying condition Trauma or injury to the head or neck Cranial or cervical vascular disease Nonvascular intracranial disorder A substance or its withdrawal Infection Affliction of homeostasis Illness of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure Psychiatric disorder (Rizzoli & Mullally, 2018). The red flag of headache If an older patient complaint of New headache Abnormal neurologic examination such as mental status changes and papilledema If there is any New change in the headache pattern Intensifying headache New headache if in case of HIV risk factors, cancer, or an immunocompromised status Systemic illness signs (e.g., fever, stiff neck, rash) If precipitate by cough, exertion, Valsalva maneuver If the Headache in pregnancy or postpartum period If a patient says it is the First or worst headache of my life (Rizzoli & Mullally, 2018). Pathophysiology of headache
- 3. Stimulation of primary nociceptors Lesions in the pain-producing pathway of PNS and CNS Pain producing structure Scalp Middle meningeal artery Dural sinuses Flax cerebri Proximal segment of the large pial arteries (Dlugasch & Story, 2020) Pathophysiology of headache continue There are no nociceptors in the brain parenchyma So the pain originates from surrounding structures, such as blood vessels, meninges, muscle fibers, facial structures, and cranial or spinal nerves. Any stretching, dilatation, constriction, or any nociceptor when they stimulate stimulation structures can cause the perception of headache. The secondary headache depends on the cause and diseases ( Rosenthal & Burchum, 2021) migraine headache Migraine headache is a headache associated with systemic complaints. The person feels a severe throbbing pain or a pulsing sensation, usually on one side of the head, along with nausea, vomiting, and extreme sensitivity to light and sound. The attacks can last for hours to days, and the pain can be severe that it interferes with daily activities (Dlugasch & Story,
- 4. 2020). Triggers to migraine headache Emotional stress Hormonal change during menstruation Alcohol intake Change in weather Odors Disturbance in sleep or not getting enough sleep migraine headache Migraine without aura Throbbing pain that starts on one side of your head, moving around tends to worsen the pain, the patient feels nauseous, dizzy, and light sensitivity and sensitivity to the sound. The duration can be from the 4 to 72 hrs. Migraine with aura The person feels visual disturbances before a migraine begins, followed by common migraine symptoms This type of migraine can range from a few minutes to a full hour, usually before the migraine attack itself starts. The migraine itself can last from 4-72 hours. Menstrual Migraine this type of Migraine started with the periods it can be last from 4 to 72 hrs. Vestibular Migraine A person can feel balance trouble, dizziness, and vertigo It can be last from a few seconds to a few days .Migraine can be without the headache
- 5. migraine headache Signs and symptoms of Migraine headache Prodromal signs; Irritability, euphoria, depression, yawing, food craving, and constipation These symptoms occur one to 2 days before the onset of headache Throbbing pain Nausea and vomiting Photophobia Phonophobia (Dlugasch & Story, 2021) migraine headache diagnostic test Detail history regarding headache Physical examination Urine drug screen to find out illicit drug use CBC, CMP, TSH, ESR Emergency CT of Head without contrast If patient complaint the worst headache CT of the head if alerted mental status or nuchal rigidity If orbital bruit is present, then needed neuroimaging LP indicated if children with AMS Sinus film in severe case to rule out mass or the lesions (Cash et al., 2021)
- 6. migraine headache drugs Valproic acid Topiramate Beta-blockers Triptans with NSAIDs for acute migraine headache Triptans for menstrual migraine Antiemetics for nausea and vomiting, which is caused by migraines Erenumab, fremanzumab, galcanezub for prophylaxis Triptan such as sumatriptan imitrex, alsuma, Rizatriptan, zolmitriptan, naratriptan for acute migraine (Cash et al., 2021) Patient teaching Educate patient about the red flags of headache Teach the patient to maintain a record for a headache at all times. Teach the patient to get enough sleep Teach about the medication, its effect, and side effects Teach about stress reduction Explain to the patient how to avoid triggers Teach about the relaxation technique (Cash et al., 2021) Tension-type headache Tension-type headache is the most common type of headache, also called the stress headache. The recurrent headaches are
- 7. mild to moderate intensity, have a bilateral location, pressing or tightening quality, and are not precipitated by routine physical activity. (Dlugasch &Story, 2020). Diagnostic tests Diagnostic test Detail history Physical exam If worse headache then CT scan of the head Symptoms and triggers of tension headache Symptoms Non-throbbing pain Head feeling dull and full Bilateral headache Not associated with nausea or photophobia Triggers Stress Tension Migraine Excessive use of smoking Excessive eye straining Overuse of caffeine or withdrawal Sinus infection or flu (Cash et al,., 2021) Pharmacological and nonpharmacological treatment of tension headache
- 8. Relieve tension Avoid triggers Improve sleep pattern Avoid caffeine Drug therapy, pain reliever is the first-line therapy Aspirin or , ibuprofen (Cash et al., 2021) Cluster headache Cluster headache is a type of headache in which a person has a short burst of unilateral orbital pain that feels several times a day. (Dlugasch & story, 2021). Signs and symptoms and diagnostic tests for cluster headache Signs and symptoms of cluster headache Most common in men It can occur at any age Smoking is the leading risk factor Headache can last a few minutes to hours Throbbing and stabbing like headache Pain along with excessive tearing Runny nose Nasal congestion and eye redness Sweating Diagnostic Based on history and physical If abnormal signs, then CT scan of the head Lithium level if the patient is taking lithium (Dlugasch & story, 2021).
- 9. Pharmacological and nonpharmacological treatment of cluster headache Avoid triggers Improve sleep pattern Suboccipital steroids injection effective prophylactic treatment Verapamil is the first line for preventive, chronic type of cluster headache In an acute attack, oxygen, sumatriptan is the treatment of choice Lithium is the second-line drug therapy for the prevention Educate patient regarding avoiding drug misuse Teach the patient regarding drugs, their action, and the side effects Teach the patient to eat a well-balanced diet (Rosenthal & Burchum, 2021) Conclusion Headache is the most common cause of pain. It's essential to use non-pharmacological methods to relieve headaches, such as behavior therapy, physical therapy, lifestyle changes. Teaching relaxation techniques that help ease muscle tension, meditation, progressive muscle relaxation, and self-hypnosis are good techniques to relieve headaches. References Cash, J. C., Glass, C. A., & Mullen, J. (2021). Family practice guidelines. Springer Publishing Company. Dlugasch, L., & Story, L. (2021). Applied pathophysiology for
- 10. the advanced practice nurse (1st ed.). Jones & Bartlett Learning. Rizzoli, P., & Mullally, W. J. (2018b). Headache. The American Journal of Medicine, 131(1), 17–24. https://doi.org/10.1016/j.amjmed.2017.09.005 Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.